Government Moves Into the Doctor's Office

President Obama is attempting to calm fears about his new health overhaul law, saying at a recent town hall meeting in Iowa that his plan "isn't a government takeover of our health care system" and if Americans "like their doctor, they'll be keeping their doctor."

That remains to be seen. A growing number of physicians who have studied the new law believe it will lead to significant government intrusion into medical decisions, and many warn they will close their practices before they will let that happen. Many Californians may find it is more difficult to find a doctor to see them than before the overhaul law was enacted.

A March survey of physicians by The Medicus Firm found that as many as a third of the nation's practicing physicians say they may close their practices and get out of the medical business entirely as a result of the health overhaul law.

Before the March vote, a Sacramento doctor wrote in the Sacramento Bee, "I can sadly predict that if this bill becomes law, in a few years it is likely many private practices will close. I would likely be forced to consider leaving my hometown and home state. Practicing here, I bear the burden of being in a high-tax state that is unfriendly to employers like me, with more regulation and lower payments than many other regions of the country."

Some of the nation's best doctors are warning they may end their careers. Dr. Dave Janda of Ypsilanti, Mich., is a nationally recognized sports injury prevention pioneer and author of a best-selling book that has been featured on Oprah and other media outlets. One of his studies on recreational injuries has saved $2 billion a year in health care costs and has lead to the prevention of 1.7 million people being injured in the United States each year. He recently told a local news outlet that he'd have no choice but to quit medicine once the health reform legislation kicks in.

And he is not alone. The expansion of coverage in the bill means that another 1.7 million people in California will be covered through MediCal, California's version of Medicaid, the public insurance plan for the poor funded jointly by the federal and state governments.

While MediCal recipients technically have a very generous benefits package, experience shows many have a hard time securing an appointment with an actual doctor. According to a recent survey by the California Health Care Foundation, only about half of the state's physicians are willing to take new MediCal patients.

But adding 1.7 million more patients to California's MediCal rolls without increasing the physician supply will make it even more difficult for the poor to find a physician.

Why are doctors turning away so many of these patients? Because they simply can't afford to treat them. For some office visits, MediCal reimburses physicians only $13. Thus, MediCal reimburses most physicians at less than their costs of treating patients so they lose money on every visit. In fact, California suffers from some of the lowest Medicaid reimbursement rates in the nation.

The health overhaul legislation tries to fix this by requiring some physicians treating Medicaid patients to be paid at the somewhat higher Medicare rates for two years. But the increased reimbursements go only to primary care doctors and won't help with patient access to medical specialists.

The new law will have implications for those with private insurance as well. Already, underpayments by Medicaid have made private health insurance more expensive because the payment rates still are generally lower than the cost of treating patients.

Doctors and hospitals have to compensate for the losses they take by charging the privately insured more.

As a result of this cost-shifting, the privately insured pay about $1,500 more for their insurance each year than they would if government programs reimbursed providers adequately. Adding millions to Medicaid will only exacerbate such cost-shifting and drive the cost of private insurance even higher.

With its estimated $19 billion budget shortfall, California's political leaders are understandably worried about how they'll pay for all these new enrollees, provide services and keep health costs under control. Officials should tread cautiously as many of their past efforts to rein in Medicaid spending have had negative consequences for patients and taxpayers alike.

For example, many states, including California, have limited doctors' ability to prescribe medicines, often forcing them to start by prescribing the cheapest drugs even when physicians know these older drugs won't work as well.

States may save money on prescription drugs in the short run, but other health spending increases as patients require more office visits and other medicines to treat side effects of the government-prescribed medicine — even incurring hospital or emergency room costs that could have been avoided.

By passing health reform, lawmakers have reserved a permanent place for themselves at the doctor's office. That's bad news for patients, because government meddling in health care has proven very costly — both medically and financially.

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President Obama is attempting to calm fears about his new health overhaul law, saying at a recent town hall meeting in Iowa that his plan "isn't a government takeover of our health care system" and if Americans "like their doctor, they'll be keeping their doctor."

That remains to be seen. A growing number of physicians who have studied the new law believe it will lead to significant government intrusion into medical decisions, and many warn they will close their practices before they will let that happen. Many Californians may find it is more difficult to find a doctor to see them than before the overhaul law was enacted.

A March survey of physicians by The Medicus Firm found that as many as a third of the nation's practicing physicians say they may close their practices and get out of the medical business entirely as a result of the health overhaul law.

Before the March vote, a Sacramento doctor wrote in the Sacramento Bee, "I can sadly predict that if this bill becomes law, in a few years it is likely many private practices will close. I would likely be forced to consider leaving my hometown and home state. Practicing here, I bear the burden of being in a high-tax state that is unfriendly to employers like me, with more regulation and lower payments than many other regions of the country."

Some of the nation's best doctors are warning they may end their careers. Dr. Dave Janda of Ypsilanti, Mich., is a nationally recognized sports injury prevention pioneer and author of a best-selling book that has been featured on Oprah and other media outlets. One of his studies on recreational injuries has saved $2 billion a year in health care costs and has lead to the prevention of 1.7 million people being injured in the United States each year. He recently told a local news outlet that he'd have no choice but to quit medicine once the health reform legislation kicks in.

And he is not alone. The expansion of coverage in the bill means that another 1.7 million people in California will be covered through MediCal, California's version of Medicaid, the public insurance plan for the poor funded jointly by the federal and state governments.

While MediCal recipients technically have a very generous benefits package, experience shows many have a hard time securing an appointment with an actual doctor. According to a recent survey by the California Health Care Foundation, only about half of the state's physicians are willing to take new MediCal patients.

But adding 1.7 million more patients to California's MediCal rolls without increasing the physician supply will make it even more difficult for the poor to find a physician.

Why are doctors turning away so many of these patients? Because they simply can't afford to treat them. For some office visits, MediCal reimburses physicians only $13. Thus, MediCal reimburses most physicians at less than their costs of treating patients so they lose money on every visit. In fact, California suffers from some of the lowest Medicaid reimbursement rates in the nation.

The health overhaul legislation tries to fix this by requiring some physicians treating Medicaid patients to be paid at the somewhat higher Medicare rates for two years. But the increased reimbursements go only to primary care doctors and won't help with patient access to medical specialists.

The new law will have implications for those with private insurance as well. Already, underpayments by Medicaid have made private health insurance more expensive because the payment rates still are generally lower than the cost of treating patients.

Doctors and hospitals have to compensate for the losses they take by charging the privately insured more.

As a result of this cost-shifting, the privately insured pay about $1,500 more for their insurance each year than they would if government programs reimbursed providers adequately. Adding millions to Medicaid will only exacerbate such cost-shifting and drive the cost of private insurance even higher.

With its estimated $19 billion budget shortfall, California's political leaders are understandably worried about how they'll pay for all these new enrollees, provide services and keep health costs under control. Officials should tread cautiously as many of their past efforts to rein in Medicaid spending have had negative consequences for patients and taxpayers alike.

For example, many states, including California, have limited doctors' ability to prescribe medicines, often forcing them to start by prescribing the cheapest drugs even when physicians know these older drugs won't work as well.

States may save money on prescription drugs in the short run, but other health spending increases as patients require more office visits and other medicines to treat side effects of the government-prescribed medicine — even incurring hospital or emergency room costs that could have been avoided.

By passing health reform, lawmakers have reserved a permanent place for themselves at the doctor's office. That's bad news for patients, because government meddling in health care has proven very costly — both medically and financially.